原发性巨细胞病毒感染对妊娠的影响

目的了解巨细胞病毒(CMV)感染对妊娠的影响。方法收集确诊为原发性CMV感染并宫内传播的孕妇50例(怀51胎)。通过羊膜穿刺术和超声检查对胎儿进行评估。在孕龄21周后，通过羊腹腔穿刺术取羊水做病毒分离培养，聚合酶链反应(PCR)分析。通过新生儿的尿液病毒分离培养或流产胎儿的组织活检确定新生儿是否感染CMV；对18例存活的新生儿进行脑超声检查、听力评估、智力发育状况评价等研究。结果50例孕妇中33例(66％)选择终止妊娠；11例(21．5％)超声检查异常的胎儿与宫内胎儿CMV感染有关，其中2例继续妊娠至足月，两者均属先天性感染，其中1例出现神经功能异常。聚合酶链反应和病毒分离培养法对50例孕妇(怀51胎)进行评价的阳性预测值分别为92．0％和93．7％。17例孕妇(怀18胎)继续妊娠至足月；4例新生儿神经功能异常，其中3例产前超声检查正常；余下14例新生儿经评估证实正常。结论羊水CMV分离培养阳性，同时PCR阳性的对象中，约94％病例被为宫内CMV感染。产前超声检查正常的胎儿中，产后出现神经功能异常的危险性为19％(3／16)。     

产前超声在妊娠期多病原体感染胎儿诊断中的应用

目的探讨妊娠期感染弓形体（TOX）、风疹病毒（Rv）、巨细胞病毒（CMv）及单纯疱疹病毒（HSV）胎儿异常超声声像图特征。方法对2011年1月至2013年3月在南京医科大学附属苏州医院苏州市立医院经免疫吸附法（ELISA）检出血清弓形体、风疹病毒、巨细胞病毒及单纯疱疹病毒特异性抗体IgM阳性孕妇的545例胎儿进行产前超声检查,总结胎儿异常超声声像图特征并随访妊娠结局。结果545例胎儿产前超声检出异常超声表现56例,包括中枢神经系统异常6例（颅内钙化灶2例、脑积水4例）;消化系统异常9例（肝内钙化灶1例、肠管回声增强8例）;心脏异常2例（室间隔缺损1例、右心增大1例）;羊水量异常17例（羊水过多16例、羊水过少1例）;胎盘异常3例（胎盘过厚1例、胎盘异常钙化2例）;泌尿系统异常13例,表现为肾窦分离;其他系统异常6例（淋巴水囊瘤1例、单脐动脉1例、骶尾部畸胎瘤1例及胎儿宫内生长受限3例）,2例胎儿为复杂畸形。56例胎儿中7例超声检查后孕妇选择引产,3例胎儿早产,2例胎死宫内,余44例随访至出生未发现其他异常。结论产前超声可发现妊娠期病原体感染所致脑积水、心脏异常等胎儿严重畸形以及颅内钙化灶、肠管回声增强、胎盘异常钙化等特征性表现,可为孕妇产前咨询和临床进一步处理提供诊断依据。     

足月妊娠孕妇羊水过少的超声诊断及妊娠结局分析

目的：探讨足月妊娠孕妇羊水过少的超声诊断,并对妊娠结局进行分析。方法选取250例羊水过少的足月妊娠孕妇为观察组,另选取同期250例羊水正常的足月妊娠孕妇为对照组,比较2组孕妇的分娩方式、胎儿情况（宫内窘迫及羊水浑浊）及妊娠结局（新生儿窒息）的发生情况。结果231例羊水量小于300 mL,超声诊断正确诊断率达92.4%。观察组孕妇的剖宫产率为82.8%,高于对照组孕妇的28.8%（P＜0.05）。观察组发生宫内窘迫以及羊水浑浊的情况高于对照组患者（均P＜0.05）。观察组新生儿窒息发生率为20.8%,高于对照组的6.4%（P＜0.05）。结论羊水过少严重影响胎儿宫内的发育以及预后,对妊娠方式的选择也会产生很大的影响,尤其会使剖宫产率增加;超声是目前诊断孕妇羊水过少最主要的方式。     

双胎中一例十二指肠闭锁超声表现及妊娠结局

孕妇,34岁,末次月经不详,初孕22岁,孕4产1,此次怀孕期间无病毒感染及放射线接触史,未服用药物,无家族遗传病史,孕20周曾于外院产前检查,超声提示:宫内妊娠(双活胎),羊水多。孕32周来我院产前常规超声检查显示:宫内妊娠,双活胎(1个胎儿羊水量正常,另1个胎儿羊水过多,最大深度15.2cm,     

妊娠早期发热与巨细胞病毒、风疹病毒、弓形体感染的关系——附120例报告

目的探讨妊娠早期(孕10周内)发热与巨细胞病毒(CMV)、风疹病毒(RV)、弓形体(TOX) 感染的关系.方法观察组120例为孕10周内发热(体温38℃至39.5℃)的孕妇,对照组为门诊进行产科检查的健康妊娠早期(孕10周内)孕妇33名,两组用酶联免疫吸附试验(ELISA) 检测 CMV、RV、TOX的免疫球蛋白 M抗体(IgM Ab), 并在孕期定期行 B超检查.结果观察组 CMV IgM Ab、RV IgM Ab、TOX IgM Ab阳性率和对照组无显著性差异(P>0.05). 妊娠早期发热孕妇的胎儿发育异常、羊水过多、羊水过少的发生率增高.结论妊娠早期中度以上发热不一定是由 CMV、风疹病毒、弓形体所引起,但孕早期发热的孕妇的产科情况异常及胎儿异常发生率增多,故亦应予孕期密切监测 .     

足月妊娠羊水过少与围生儿结局

目的分析羊水过少足月妊娠孕妇围生儿结局,以降低妊娠不良结局。方法 227例足月妊娠羊水过少患者为观察组,同期羊水量正常孕妇100名为对照组,比较2组胎心电子监护结果及胎儿宫内窘迫、羊水Ⅲ度污染、新生儿窒息发生率。结果观察组剖宫产率、胎儿宫内窘迫及羊水Ⅲ度污染发生率、围生儿病死率均高于对照组(P<0.05)。结论对羊水过少产妇应加强胎儿宫内监护,以预防新生儿窒息等妊娠不良结局发生。     

羊水浑浊新生儿脐带血血气分析应用研究

目的探讨脐带血血气分析在羊水浑浊新生儿中的应用价值。方法 178例因胎儿宫内窘迫行剖宫产的足月妊娠孕妇作为研究组,760例择期行剖宫产术的健康孕妇作为对照组,比较两组羊水性状、新生儿Apgar评分及脐带血pH值。结果两组孕妇羊水性状、新生儿Apgar评分及脐带血pH值异常发生率比较差异有统计学意义(P0.05)。结论羊水浑浊可导致胎儿宫内窘迫、新生儿窒息、新生儿酸中毒。脐带血血气分析可弥补Apgar评分的不足,提高新生儿疾病诊断率。     

妊娠合并单增李斯特菌感染56例

目的:探究对妊娠合并单增李斯特菌感染孕妇首发表现、治疗状况、妊娠结局与影响因素,为临床提供指导。方法:将2019年1月至12月北京市通州区妇幼保健院内科门诊56例妊娠合并单增李斯特菌感染孕妇作为主要研究对象,采用回顾性分析方法总结妊娠期单增李斯特菌感染的发病特点、表现、治疗和预后。结果:在56例孕妇中,血培养呈阳性36例,阴道分泌物培养阳性25例。首发表现以胎膜早破、先兆早产、产前发热、胎儿宫内窘迫等为主。活产分娩有36例,活产分娩率为64.29%。足月10例,早产26例。胎死宫内16例,其中4例为流产。在36例活产分娩新生儿中,6例孕妇在抗感染治疗足月分娩。30例被感染新生儿,治愈/好转10例,5例死亡,15例放弃治疗。结论:妊娠合并李斯特菌感染会使早产概率明显提高,致使死胎或者是流产,具有较高的母婴共患概率。因此,如果孕产妇出现发热、胎儿宫内窘迫或者是先兆流产的情况,需警惕李斯特菌感染,以免对妊娠结局与新生儿预后带来负面影响。     

羊水过少并脐带绕颈与不良围产结局关系的研究

本研究选择2011年12月-2013年2月期间我院行B超检查提示羊水过少合并脐带绕颈孕妇80例孕产妇为研究对象,作为研究组,选择同期我院B超检查正常孕妇80例为对照组,对比分析两组羊水胎粪污染、胎儿宫内窘迫、新生儿窒息等不良围产结局的发生率。结果研究组80例孕产妇羊水胎粪污染、胎儿宫内窘迫、新生儿窒息发生率分别为35.00%、27.50%、21.25%,对照组80例孕产妇发生率分别为6.25%、3.75%、5.00%,各种围产期不良结局发生率比较差异具有统计学意义（P＜0.05）。羊水过少并脐带绕颈孕产妇发生不良围产结局明显高于正常孕产妇,产前超声检查具有十分重要的临床意义,为临床医师对羊水过少并脐带绕颈孕产妇加强产前和产时胎儿监护,积极针对不同情况采取相应措施,从而降低和避免由于羊水过少或脐带绕颈而导致的不良结局。     

孕期人巨细胞病毒感染与不良妊娠结局的探讨

目的通过分析南昌地区孕妇巨细胞病毒(CMV)感染的情况,探讨母孕期感染状态与不良妊娠结局的相关性,为预防母孕期CMV感染,降低出生缺陷提供科学依据。方法根据2015-2017年南昌市16551例孕妇的新生儿结局,305例有不良妊娠结局的孕妇纳入病例组,同时随机选取412例正常妊娠结局的孕妇为正常对照。采用酶联免疫吸附试验测定孕妇外周血CMV IgG、IgM抗体及IgG亲合力指数(avidity index,AI),用荧光定量多聚酶链反应(FQ-PCR)技术测定孕妇血中HCMV-DNA含量。结果病例组CMV IgG+/IgM+孕妇活动感染率明显高于正常对照组(3.9%vs 1.2%),差异有统计学意义(P=0.023)。CMV IgG AI检测结果显示,对照组孕妇5例均为IgG AI≥50%(1.2%),说明无原发感染,而病例组孕妇4例IgG AI30%(1.3%),提示原发感染(P=0.078),这4例母亲的新生儿均出现不良妊娠结局,包括2例生长发育迟缓、1例化脓性脑膜炎及1例头颅畸形。HCMV-DNA结果显示,病例组孕妇HCMV-DNA阳性例数所占比例显著高于正常妊娠孕妇。结论CMV感染在南昌地区孕妇人群中普遍存在,少部分孕妇在孕期发生活动性感染,且可导致胎儿及新生儿不良结局。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.